Does structural racism impact receipt of NCCN guideline-concordant breast cancer treatment?
| Autor: | Lubarsky M; University of Miami Miller School of Medicine, Miami, FL, USA., Hernandez AE; Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA., Collie BL; Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA., Westrick AC; University of Michigan School of Public Health, Ann Arbor, MI, USA., Thompson C; Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA., Kesmodel SB; Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA.; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA., Goel N; Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA. neha.goel@med.miami.edu.; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA. neha.goel@med.miami.edu.; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA. neha.goel@med.miami.edu.; Division of Surgical Oncology | Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street | Suite 410, Miami, FL, 33136, USA. neha.goel@med.miami.edu. |
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| Jazyk: | angličtina |
| Zdroj: | Breast cancer research and treatment [Breast Cancer Res Treat] 2024 Aug; Vol. 206 (3), pp. 509-517. Date of Electronic Publication: 2024 May 29. |
| DOI: | 10.1007/s10549-024-07245-6 |
| Abstrakt: | Purpose: Disparities in breast cancer survival remain a challenge. We aimed to analyze the effect of structural racism, as measured by the Index of Concentration at the Extremes (ICE), on receipt of National Cancer Center Network (NCCN) guideline-concordant breast cancer treatment. Methods: We identified patients treated at two institutions from 2005 to 2017 with stage I-IV breast cancer. Census tracts served as neighborhood proxies. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed to create 5 models, controlling for economic segregation, non-Hispanic Black (NHB) segregation, NHB/economic segregation, Hispanic segregation, and Hispanic/economic segregation. Multi-level logistic regression models were used to determine the association between individual and neighborhood-level characteristics on receipt of NCCN guideline-concordant breast cancer treatment. Results: 5173 patients were included: 55.2% were Hispanic, 27.5% were NHW, and 17.3% were NHB. Regardless of economic or residential segregation, a NHB patient was less likely to receive appropriate treatment [(OR) Conclusion: To our knowledge, this is the first analysis assessing receipt of NCCN guideline-concordant treatment by ICE, a validated measure for structural racism. While much literature emphasizes neighborhood-level barriers to treatment, our results demonstrate that compared to NHW patients, NHB patients are less likely to receive NCCN guideline-concordant breast cancer treatment, independent of economic or residential segregation. Our study suggests that there are potential unaccounted individual or neighborhood barriers to receipt of appropriate care that go beyond economic or residential segregation. (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.) |
| Databáze: | MEDLINE |
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